Request a Live Segway Demonstration

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REQUEST A LIVE SEGWAY DEMONSTRATION
* Required before submitting

NAME:	*
COMPANY(if applicable):
CITY:	*

PHONE:	*
FAX (if applicable)::
CELL:

EMAIL:	*

INTEREST IN THE SEGWAY IS:	*
IF OTHER, PLEASE EXPLAIN:
HOW DID YOU HEAR ABOUT US?	*
WHICH OF THE SEGWAY MODELS INTEREST YOU THE MOST?	i2 COMMUTER x2 ADVENTURE POLICE GOLF CARGO *
HOW MANY SEGWAYS ARE YOU INTERESTED IN PURCHASING?	*
WHAT DO YOU PLAN TO DO WITH THE SEGWAY(S) YOU PURCHASE?	*
HOW MANY DO YOU EXPECT TO ATTEND THIS DEMO?	*
WOULD YOU PREFER A MORNING OR AFTERNOON DEMO?	MORNING AFTERNOON EITHER *